Intraoperative Cholangiography in Laparoscopic Cholecystectomy: Technique and Changing Indications

• Main Author: Kamer Tomaoğlu
• Format: Article
• Language: English
• Published: Galenos Yayinevi 2020-09-01
• Series: İstanbul Medical Journal
• Subjects: laparoscopic; cholecystectomy; intraoperative; cholangiography
• Online Access: http://istanbulmedicaljournal.org/archives/archive-detail/article-preview/ntraoperative-cholangiography-in-laparoscopic-chol/40206

Introduction:Although laparoscopic cholecystectomy (LC) is considered as the “gold standard” of cholecystectomy, the rate of bile duct injuries seems to be elevated when compared to open cholecystectomy. Intraoperative cholangiography (IOC) may prevent iatrogenic bile duct injuries or may diagnose missed bile duct injuries.Methods:Between 1998 and 2016, 29 selective IOCs were performed in a total of 212 LCs (13.7%). At the beginning of the study (1998-2002), the indications of IOC were past history of jaundice, elevation of cholestatic enzymes and dilation of the common bile duct or suspicion of common bile duct stones on abdominal ultrasound, whereas obscure biliary anatomy became the main intraoperative criteria during the following years.Results:Of the 29 patients, 20 were female and 9 patients were male. The mean age was 54.4 years. IOC was successful in 26 cases (90%). The median IOC time was 21.9 minutes. An anatomical variation was found in one patient. In this case, the cystic duct was opening into the right hepatic duct. The Wirsung duct was visualised in another patient, which was probably due to hyperpression of the sphincter of Oddi. No complication related to the procedure itself was encountered.Conclusion:Although the routine use of IOC does not seem to be necessary, it may prevent bile duct injuries in selected cases. Surgeons should gain experience in performing the procedure, and the necessary equipment should be present in the operating room.